Equivalent Analgesia and Side Effects during Epidural and Pharmacokinetically Tailored Intravenous Infusion with Matching Plasma Alfentanil Concentration 

1999 ◽  
Vol 90 (1) ◽  
pp. 98-108 ◽  
Author(s):  
Barbara A. Coda ◽  
Mary Cleveland Brown ◽  
Linda BS Risler ◽  
Karen Syrjala ◽  
Danny D. Shen
Keyword(s):  
Side Effects ◽  
Intravenous Administration ◽  
Intravenous Infusion ◽  
Test Battery ◽  
Systemic Absorption ◽  
Subjective Rating ◽  
Intravenous Infusions ◽  
Upper And Lower Extremities ◽  
Intravenous Saline ◽  
End Tidal

Background Recently, several clinical studies comparing intravenous and epidural infusions of fentanyl and its derivatives suggested that epidural infusions act primarily by systemic absorption to produce supraspinal analgesia. To evaluate this hypothesis, the authors used pharmacokinetically tailored intravenous infusions to produce matching plasma alfentanil concentrations during epidural and intravenous administration. The analgesia and side effects achieved with each mode of administration were compared. Methods Twelve volunteers participated in this placebo-controlled crossover study. The pain model was cutaneous electric stimulation of the finger and toe. The test battery included subjective rating of pain intensity; end-tidal carbon dioxide level; pupil size; ratings of alertness, nausea, and pruritus; and a plasma alfentanil assay. On one test day, the participants received epidural alfentanil (400 microg bolus + a 400-microg/h infusion for 2 h) and an intravenous saline infusion. The test battery was administered at regular intervals. On another test day, the participants received epidural saline and a computer-controlled intravenous infusion of alfentanil. The testing protocol was repeated as on the first test day. On the day the placebo was administered, the participants received epidural and intravenous saline infusions. The order of the placebo day was randomized. Results Plasma alfentanil concentration-time profiles were identical during epidural and intravenous infusions. A nearly equivalent analgesic response was observed with epidural and intravenous alfentanil at the upper and lower extremities. There were no differences in side effects for epidural and intravenous administration. Conclusions The systemic redistribution of alfentanil accounts for most of the analgesia and effects produced by epidural infusion.

ÜBER DIE WIRKUNG PHARMAKOLOGISCHER OXYTOCINDOSEN AUF DIE MILCHDRÜSE

1960 ◽  
Vol XXXIV (IV) ◽  
pp. 543-557 ◽  
Author(s):  
B. Berde ◽  
A. Cerletti
Keyword(s):  
Mammary Gland ◽  
Intravenous Administration ◽  
Intravenous Infusion ◽  
Intranasal Administration ◽  
Intramuscular Injection ◽  
Different Types ◽  
Lactating Mammary Gland ◽  
Synthetic Oxytocin

ABSTRACT A study was made of the influence of pharmacological amounts of synthetic oxytocin (»Syntocinon«) on the lactating mammary gland of the rabbit. The drug was given by intravenous infusion, by intramuscular injection and by intranasal administration. Two different types of reaction were noted: a tonic reaction, i. e. a lasting increase in pressure in the mammary gland without significant fluctuations, or a rhythmic reaction, i. e. a series of increases in pressure at more or less regular intervals. In order to elicit reactions approximately identical in intensity and character with those produced by intravenous infusion, it was necessary to give approximately 1.5 to 8.0 times as much by intramuscular injection and approximately 10 to 100 times as much by intranasal administration. Intravenous administration of adrenaline transiently suppressed a long-lasting reaction to oxytocin.

scholarly journals Dr Thomas Latta: the father of intravenous infusion therapy

2009 ◽  
Vol 10 (1_suppl) ◽  
pp. S3-S6 ◽  
Author(s):  
Neil MacGillivray
Keyword(s):  
Twentieth Century ◽  
Intravenous Infusion ◽  
Medical Profession ◽  
Saline Infusion ◽  
Infusion Therapy ◽  
Cholera Epidemic ◽  
New Therapy ◽  
Intravenous Saline

The paper reviews the work of Dr Thomas Latta who during the cholera epidemic of 1831—32 pioneered the use of intravenous saline infusion in the treatment of cholera. The reaction of the medical profession to this new therapy is described and the reasons for the profession’s failure to acknowledge the importance of this advance is analysed. The reasons why the name of Thomas Latta and his contribution did not survive his death in 1833 are discussed and the contributions of twentieth century scholars in remembering his work are highlighted.

Dr. Shannon Replies

PEDIATRICS ◽  
1975 ◽  
Vol 56 (4) ◽  
pp. 619-619
Author(s):  
Daniel C. Shannon
Keyword(s):  
Gastrointestinal Tract ◽  
Side Effects ◽  
Intravenous Administration ◽  
Ductus Arteriosus ◽  
Oral Feeding ◽  
Blood Levels ◽  
Severe Toxicity ◽  
Potential Toxicity ◽  
Nasojejunal Tube ◽  
Rectal Route

Dr. Morens raises questions of potential toxicity of theophylline in the gastrointestinal tract, kidney and ductus arteriosus. Except for vomiting, which has occurred in some infants when blood levels have been excessive (mainly 2Oµg/ml), we have not observed any of these side effects in treating 93 infants. In all infants, treatment was given through a nasogastric or nasojejunal tube until oral feeding was possible. Because acute severe toxicity in children and adults has been related to intravenous administration, we have used this route only when necessary. Because of erratic absorption, we have avoided the rectal route.

scholarly journals Complications after Intrathecal Drug Delivery Due to the Underlying Malignancy in Two Patients with Intractable Cancer Pain

2013 ◽  
Vol 2;16 (2;3) ◽  
pp. E107-E111
Author(s):  
Thomas Chai
Keyword(s):  
Drug Delivery ◽  
Side Effects ◽  
Cancer Pain ◽  
Systemic Absorption ◽  
Pain Patient ◽  
Drug Side Effects ◽  
Intrathecal Drug Delivery ◽  
Underlying Malignancy ◽  
History Of ◽  
Intractable Cancer Pain

Intrathecal drug delivery is a mode of analgesic delivery that can be considered in those experiencing both refractory pain and excessive side effects from opioid and adjuvant analgesic use. Delivery of analgesic agents directly to the cerebral spinal fluid allows binding of the drug to receptors at the spinal level. Therefore, a reduced analgesic dosage can be afforded, resulting in reduction of drug side effects due to decreased systemic absorption. Drug delivery into the intrathecal space provides this benefit, yet it does not eliminate the possibility of drug side effects or risks of complications. Complications from this route of administration may be seen in the perioperative period or beyond, including infection, inflammatory mass, bleeding, and catheter or pump dysfunction, among others. This may manifest as new/worsening pain or as a neurologic deficit, such as a sensorimotor change and bladder/bowel dysfunction. Urgent evaluation with a detailed physical examination, device interrogation, and other workup including imaging is called for if symptoms suspicious for device-related problems arise. For the cancer pain patient, the underlying malignancy should also be considered as a potential cause for these new symptoms after intrathecal system implantation. We present 2 such cases of complications in the cancer pain patient after intrathecal drug delivery due to progression of the underlying malignant process rather than to surgical or device-related problems. The first patient had a history of metastatic osteosarcoma who, shortly after undergoing an intrathecal drug delivery trial with external pump, presented with new symptoms of both pain and neurologic changes. The second patient with a history of chondrosarcoma developed new symptoms of pain and sensorimotor change several days after intrathecal drug delivery system implantation. Key words: Intrathecal analgesia, intrathecal drug delivery, perioperative complications, cancer pain, malignant pain, pain pump

Side Effects of Sugar Substitutes during Intravenous Administration

1975 ◽  
Vol 18 (1) ◽  
pp. 227-241 ◽  
Author(s):  
D.W. Thomas ◽  
J.B. Edwards ◽  
R.G. Edwards
Keyword(s):  
Side Effects ◽  
Intravenous Administration ◽  
Sugar Substitutes

Rapidly Administered Hypertonic Solutions

PEDIATRICS ◽  
1971 ◽  
Vol 47 (1) ◽  
pp. 154-154
Author(s):  
Robert L. Harris
Keyword(s):  
Total Dose ◽  
Intravenous Infusion ◽  
Human Organism ◽  
Physiological Changes ◽  
Valuable Addition ◽  
Hypertonic Solutions ◽  
Intravenous Infusions ◽  
Clinically Significant

The article "Clinically Significant Physiological Changes from Rapidly Administered Hypertonic Solutions: Acute Osmol Poisoning" (Pediatrics, 46:267, 1970) by Kravath, et al. is a valuable addition to the pediatric literature. In a series of interesting experiments the authors again document the potential dangers of rapid intravenous infusions of hypertonic solutions. However, the implication that the experiments so performed are necessarily applicable inthe human organism need some clarification. In considering the effects of an intravenous infusion in the human, three factors should be considered: (1) osmoiality, (2) volume, and (3) total dose.

About the method of treatment of gonorrhea and its complications according to the method of O. Sachs'a

1930 ◽  
Vol 26 (2) ◽  
pp. 177-181
Author(s):  
С. Yu. Rothstein
Keyword(s):  
Intravenous Infusion ◽  
Psoriasis Vulgaris ◽  
Combined Treatment ◽  
Local Therapy ◽  
Average Amount ◽  
Duration Of Treatment ◽  
Complete Cure ◽  
Intravenous Infusions ◽  
First Time ◽  
Number Of Injections

O. Sachs, who for the first time proposed intravenous infusion of 20% sterile salicylic pagra solution for the treatment of psoriasis vulgaris, recommends this method to be used in the treatment of gonorrhea, especially its complications. In total, he conducted 103 cases of gonorrhoid urethritis in this way, in the overwhelming number complicated by epididymitis, funiculitis and prostatitis. In 72 patients, he used exclusively intravenous infusions of salicylic sodium, and in the rest, he also used local therapy before, during and after the infusions. He received excellent results from this method of treatment. Out of 72 patients who used only intravenous infusions of salicylic sodium, complete cure was achieved in 39 cases (54.16%), improvement in 32 cases (44.44%), and a negative result in only one. The duration of treatment on average was 21.5 days, each patient had 6.5 injections, with an average amount of salicylic sodium administered in 18.9 grams. With combined treatment, the percentage of complete cure increases even more, but with a larger number of injections and a longer duration period of treatment.

Attenuation of IL-2-induced multisystem organ edema by phalloidin and antamanide

1991 ◽  
Vol 70 (3) ◽  
pp. 1364-1368 ◽  
Author(s):  
R. Welbourn ◽  
G. Goldman ◽  
L. Kobzik ◽  
C. R. Valeri ◽  
H. B. Hechtman ◽  
...  
Keyword(s):  
Endothelial Cell ◽  
Side Effects ◽  
Bronchoalveolar Lavage ◽  
Protein Concentration ◽  
Interleukin 2 ◽  
Cell Junction ◽  
Elevated Protein ◽  
Intravenous Saline

Interleukin 2 (IL-2) is a potent cytokine with diverse effects, including the ability to stimulate lymphocyte differentiation into cells capable of lysing tumor. Its therapeutic efficacy is limited because of side effects such as breakdown of the microvascular barrier and edema. Control of the microvascular barrier is in part regulated by endothelial cell cytoskeletal contractile proteins. This study tests whether the cyclopeptides that maintain actin filament organization and distribution and reduce macromolecular flux across the endothelial cell junction in vitro would similarly maintain barrier tightness and prevent early edema produced by IL-2 in vivo. Anesthetized rats were treated at 30-min periods with intravenous saline (0.5 ml, n = 41), phalloidin (20 micrograms in 0.5 ml, n = 21), or antamanide, (20 micrograms in 0.5 ml, n = 21), starting 30 min before the 1-h infusion of 10(6) U of recombinant human IL-2 or saline. Six hours after the start of IL-2, there was edema in the saline/IL-2 group, as measured by increased wet-to-dry ratios (W/D) in the lungs, heart, and kidney. With saline/IL-2, bronchoalveolar lavage (BAL) fluid contained an elevated protein concentration and higher plasma thromboxane levels compared with controls. The number of neutrophils sequestered in the lungs was more than twice that of saline controls. Phalloidin significantly attenuated edema in lung and reduced BAL protein leak. Antamanide treatment was as effective in limiting lung and heart edema, but, in contrast to phalloidin, antamanide prevented kidney edema and did not lead to an alteration in the liver W/D. Antamanide also prevented BAL fluid protein leak.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of intravenous administration of a fat emulsion on blood coagulation in dogs

1959 ◽  
Vol 196 (5) ◽  
pp. 1015-1019 ◽  
Author(s):  
Harrison H. Shoulders ◽  
Robert C. Hartmann ◽  
H. C. Meng
Keyword(s):  
Blood Coagulation ◽  
Intravenous Administration ◽  
Intravenous Infusion ◽  
Bleeding Time ◽  
Plasma Fibrinogen ◽  
Fibrinogen Concentration ◽  
Clotting Time ◽  
Clot Retraction ◽  
Fat Emulsion ◽  
Abnormal Bleeding

A fat emulsion prepared for intravenous administration has been studied with regard to its effect upon blood coagulation in dogs. The most characteristic effects found during intravenous infusion of this material at a rate of 1 ml/min. were thrombocytopenia and marked shortening of clotting time. These effects were invariably observed in animals which had not previously received the emulsion. When subsequent infusions were given within 3 hours, no significant changes were observed. When the interval was extended to 1–13 days, variable responses occurred, at times characterized by pronounced hypocoagulability. If the repeat infusion was given 2 weeks or more after the initial one, the effects were similar to those observed during the first infusion. The prothrombin and thrombin clotting times and plasma fibrinogen concentration were not greatly altered during the infusion. Abnormal bleeding time, ‘prothrombin utilization’ and clot retraction accompanied the thrombocytopenia.

Clinical Evaluation of High Weekly Intravenous Doses of Methotrexate in Advanced Oropharyngeal Carcinoma

1970 ◽  
Vol 56 (5) ◽  
pp. 259-268 ◽  
Author(s):  
Giuseppe M. de Palo ◽  
Mario De Lena ◽  
Roberto Molinari ◽  
Antonio Cunsolo ◽  
Silvio Monfardini ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Side Effects ◽  
Intravenous Administration ◽  
Renal Toxicity ◽  
Severe Depression ◽  
Response To Treatment ◽  
Oropharyngeal Carcinoma ◽  
Intraarterial Infusion ◽  
Intravenous Injections ◽  
Duration Of Response

Methotrexate (MTX) was given by weekly rapid intravenous injections to 27 patients with inoperable oropharyngeal carcinoma. 9 cases were untreated while 18 had received radiotherapy or chemotherapy before administration of MTX. In 20 cases the dose was 40 mg/m2/week (patients over 50 years) and in 7 cases 60 mg/m2/week (table 1). In responsive patients, maintenance treatment was given at the dose of 15 mg/m2 every 4 days either orally or intramuscularly. 23 cases were adequately evaluable, i.e. they received treatment for a minimum of 3 weeks. Response to treatment was evaluated according to Karnofsky's scale. Considering only category 1 regressions, 11/16 (75%) patients adequately treated with 40 mg/m2 showed objective improvement and respectively 4/7 (57%) given 60 mg/m*. 8 out of 15 cases (41%) with category 1 response showed a regression greater than 50%. The mean duration of response for category 1 patients was 3.5 months, while the longest regression lasted 9 months (table 2). 18 patients had one or more side effects: 9 had oral lesions or gastroenteritis, 12 bone marrow depression, 3 hepatic and 1 renal toxicity. One patient died from hepatic and renal toxicity; in the remaining cases the side effects were quickly reversible (table 3). The percent regression rate for category 1 response and its average duration obtained with intravenous MTX seems comparable to intraarterial infusion (table 4). Systemic toxicity seems also comparable (table 5). Furthermore, intravenous administration obviates the typical local complications occurring with intra-arterial treatment and therapy can be given also at outpatients. For this reason, intravenous administration of MTX is preferred to intra-arterial infusion in the control of primary inoperable oropharyngeal carcinomas, provided no severe depression of liver, kidney and bone marrow is present.

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